Provider Demographics
NPI:1992538458
Name:GOODWIN, HANNA ESTHAY
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:ESTHAY
Last Name:GOODWIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 KENT HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0610
Mailing Address - Country:US
Mailing Address - Phone:337-329-5747
Mailing Address - Fax:
Practice Address - Street 1:601 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5726
Practice Address - Country:US
Practice Address - Phone:337-436-1370
Practice Address - Fax:337-436-1621
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206384163WM0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn